Cerebral Protection by Lidocaine During Cardiac Operations: A Follow-Up Study

Mitchell, Simon J; Merry, Alan; Frampton, Christopher M.; Davies, Elaine; Grieve, D; Mills, Brigid P.; Webster, Craig; Milsom, F. Paget; Willcox, Timothy W.; Gorman, D

doi:10.1016/j.athoracsur.2008.12.042

Cited by 65 publications

(60 citation statements)

References 17 publications

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“…Lidocaine has been used in continuous infusion, but its use is not currently recommended, and may even increase cognitive dysfunction in diabetics (66).…”

Section: Methods Of Pharmacological Cerebral Protectionmentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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“…Lidocaine has been used in continuous infusion, but its use is not currently recommended, and may even increase cognitive dysfunction in diabetics (66).…”

Section: Methods Of Pharmacological Cerebral Protectionmentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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“…The lidocaine infusion was terminated either at skin closure or the end of the surgical procedure [45,186,188,[190][191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206]; 1 h after surgery/skin closure [207][208][209][210][211][212]; 1 h after arrival in the post anaesthesia care unit (PACU) [213]; 4 h post-operatively [214]; up to 8 h post-operatively (or at PACU discharge whichever occurred earlier) [187]; after a total of 12 h [215]; 24 h post-operatively [216][217][218][219][220][221][222][223]; 48 h post-operatively [215,[224][225][226]; or on the day of return of bowel function or, at the latest, on the fifth post-operative day [189]. One study did not report the cessation time for the lidocaine infusion [227].…”

Section: Role Of Ivlt In Acute Perioperative Painmentioning

confidence: 99%

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

Lauder¹

2017

Pain Relief - From Analgesics to Alternative Therapies

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Pediatric acute and chronic pain experiences involve the interaction of physiological, psychological, behavioural, developmental, pharmacological and situational factors. In the acute perioperative pain setting preventative multimodal analgesia is required to provide comfort and minimise the potential for "wind-up" and central sensitisation. When pain is recurrent, ongoing or chronic some children embark on a downward spiral of decreased physical, psychological and social functioning. The multidisciplinary team management approach is a well-established standard of care for children with complex chronic pain. Intravenous lidocaine has peripheral and central mediated analgesic, anti-inflammatory and anti-hyperalgesic properties. Intravenous lidocaine infusion therapy (IVLT) has been shown to be effective in the management of acute and chronic pain in adults. This chapter will present the rational for IVLT in pediatric pain management with emphasis on preventative multimodal therapy in acute pain and the multidisciplinary treatment approach in chronic pain. Large multi-centre randomised controlled trials are required to provide the evidence-base to confirm that IVLT is indeed an effective and safe treatment option in acute preventative multimodal analgesia and as an adjunct in the multidisciplinary care of chronic pain in the pediatric population. Keywords

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“…More recently, 2 RCTs that tested the neuroprotective effects of lidocaine failed to confirm a reduction in POCD [48, 49]. In one of these trials, lidocaine was evaluated in 158 patients who underwent elective cardiac surgery for coronary artery disease and/or cardiac valve surgery.…”

Section: Perioperative Neuroprotection With Intravenous Anestheticsmentioning

confidence: 99%

“…In one of these trials, lidocaine was evaluated in 158 patients who underwent elective cardiac surgery for coronary artery disease and/or cardiac valve surgery. Patients randomly assigned to the treatment group received, on induction of general anesthesia, lidocaine as a bolus of 1 mg/Kg over 5 minutes, followed by 2 mg/min for 2 hours, and 1 mg/min thereafter for a total of 12 hours [48]. The neurocognitive tests were performed on the day before surgery, and were repeated at 10 and 25 weeks postoperatively.…”

Section: Perioperative Neuroprotection With Intravenous Anestheticsmentioning

confidence: 99%

Neuroprotective Effects of Intravenous Anesthetics: A New Critical Perspective

Bilotta¹,

Stazi²,

Zlotnik³

et al. 2014

CPD

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Perioperative cerebral damage can result in various clinical sequela ranging from minor neurocognitive deficits to catastrophic neurological morbidity with permanent impairment and death. The goal of neuroprotective treatments is to reduce the clinical effects of cerebral damage through two major mechanisms: increased tolerance of neurological tissue to ischemia and changes in intra-cellular responses to energy supply deprivation. In this review, we present the clinical evidence of intravenous anesthetics on perioperative neuroprotection, and we also provide a critical perspective for future studies. The neuroprotective efficacy of the intravenous anesthetics thiopental, propofol and etomidate is unproven. Lidocaine may be neuroprotective in non-diabetic patients who have undergoing cardiac surgery with cardiopulmonary bypass (CBP) or with a 48-hour infusion, but conclusive data are lacking. There are several limitations of clinical studies that evaluate postoperative cognitive dysfunction (POCD), including difficulties in identifying patients at high-risk and a lack of consensus for defining the “gold-standard” neuropsychological testing. Although a battery of neurocognitive tests remains the primary method for diagnosing POCD, recent evidence suggests a role for novel biomarkers and neuroimaging to preemptively identify patients more susceptible to cognitive decline in the perioperative period. Current evidence, while inconclusive, suggest that intravenous anesthetics may be both neuroprotective and neurotoxic in the perioperative period. A critical analysis on data recorded from randomized control trials (RCTs) is essential in identifying patients who may benefit or be harmed by a particular anesthetic. RCTs will also contribute to defining methodologies for future studies on the neuroprotective effects of intravenous anesthetics.

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Cerebral Protection by Lidocaine During Cardiac Operations: A Follow-Up Study

Cited by 65 publications

References 17 publications

Intraoperative care for aortic surgery using circulatory arrest

Intraoperative care for aortic surgery using circulatory arrest

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

Neuroprotective Effects of Intravenous Anesthetics: A New Critical Perspective

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